Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | ||
N | 2251S0007X | Physical Therapist - Sports | 1947 | SD |
NPI | 1467967828 |
---|---|
Provider Name | Dr. Matthew Rollag |
First Address | Sioux Falls, SD 57107-1104 |
Second Address | Sioux Falls, SD 57104-4651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2017 |
Last Update Date | 17/03/2018 |